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Prison suicide: rates and prevention policies.

Historically, little is known about the issue of prison suicide, a research topic that has been characterized as a victim of relative neglect in criminology and corrections (Austin and Unkovic 1977). Recently, the National Center on Institutions and Alternatives (NCIA) completed a monograph on prison suicide for the National Institute of Corrections. The 108-page monograph, Prison Suicide: An Overview and Guide to Prevention, presents a thorough discussion of the literature, a review of national and state standards for prison suicide prevention, national data on the incidence and rate of prison suicide, effective prison suicide prevention programs and a discussion of liability issues (Hayes 1995). Summarized below are key findings related to suicide rates and prevention policies.

Prison Suicide Rates:

A 10-year Review

Suicide ranks third behind natural causes and AIDS as the leading cause of death in Prisons within the United States (Bureau of Justice Statistics 1993). To measure the severity of the problem, researchers invariably calculate the rate of suicide within prison systems. To date, however, few national studies of prison suicide rates have been conducted; therefore, our existing knowledge base is limited to research on individual state prison systems reporting widely disparate findings. For example, Anno (1985) determined that the suicide rate was 18.6 per 100,000 inmates in the Texas prison system; Salive et al (1989) calculated a suicide rate of 39.6 for male prison inmates in Maryland, and Batten (1992) found an average suicide rate of 53.7 in the Oregon prison system during the 25-year period of 1963 through 1987. In addition, rates of suicide within the same prison system can vary widely from year to year. For example, the California Department of Corrections (1994) determined that the rate of suicide in its prison facilities decreased from 17 per 100,000 inmates in 1990 to 14 per 100,000 in 1992, while dramatically and inexplicably rising to 25 per 100,000 inmates in 1993.

The limited research available on national prison suicide rates is both somewhat dated and plagued by inconsistent reporting problems. Lester (1982, 1987) cited previous calculations of national prison suicide rates for two periods: 1978 to 1979 and 1980 to 1983. The rate of suicide for male inmates was 24.6 and 24.3, respectively, for these two periods. Unfortunately, the above calculations were based on nationally reported Bureau of Justice Statistics (BJS) data that were underreported. For example, the most recent data available on prison suicide from the BJS reported a total of 89 Prison suicides throughout the united States in 1991. This total, however, does not include data from six "nonreporting" jurisdictions, as well as an unknown number of possible suicides contained within inmate death data listed by BJS as "unspecified causes." Excluding nonreporting jurisdictions, the national prison suicide rate based on BJS data would be 13.9 suicides per 100,000 inmates. This rate is low, how ever, compared to other data. For example, analyzing annual national survey data from both the Criminal Justice Institute (1992) and Corrections Compendium (1992) as well as from telephone follow-up with several jurisdictions, NCIA was able to verify 127 prison suicides for all state and federal prison during 1991. Thus, a more accurate national prison suicide rate for 1991 would be 16.4 suicides per 100,000 inmates.

In an effort to collect the most recent national data on prison suicides, NCIA surveyed all 50 state departments of correction (DOC), plus the District of Columbia and the Federal Bureau of Prisons and inquired as to the number of inmate suicides each prison system had during 1993. In addition, to review historical trends in the rate of prison suicide throughout the country, we gathered and analyzed data from the 1984 through 1992 annual surveys of both the criminal justice Institute and Corrections Compendium. Table 1 presents the aggregate nine year (1984-1992) total of prison suicides and rates combined with NCIA's 1993 data. As indicated, there were 1,339 suicides in state and federal prisons throughout die United States between 1984 and 1993, resulting in a 10-year suicide rate of 20.6. California led all states with 176 prison suicides, with New Mexico reporting only two suicides during the 10-year period. New Mexico also had the lowest suicide rate (7.1), while North Dakota had the highest (101.7) -- perhaps a misleading statistic since this prison system has not experienced an inmate suicide since 1988. In addition, 10 large jurisdictions (Arizona, California, Florida, Illinois, Michigan, New York, Ohio, Pennsylvania, Texas and the Federal Bureau of Prisons) accounted for almost 50 percent of all suicides yet had a combined suicide rate below the national rate (17.8 versus versus 20.6).

Table 1. Total Prison Suicides and Rates by State -- 1984-1993

 State Suicides Total Inmate Rate
 Population

Alabama 17 122,117 13.9
Alaska 20 22,921 87.3
Arizona 38 125,059 30.4
Arkansas 13 59,459 21.9
California 176 779,724 22.6
Colorado 17 54,005 31.5
Connecticut(*) 32 85,857 37.3
Delaware(*) 7 30.625 22.9
District of Columbia(*) 13 83,309 15.6
Florida 43 385,035 11.2
Georgia 34 205,828 16.5
Hawaii(*) 7 22,416 31.2
Idaho 7 16,763 41.8
Illinois 38 242,998 15.6
Indiana 20 117,613 17.0
Iowa 6 37,667 15.9
Kansas 12 53,604 22.4
Kentucky 14 66,357 21.1
Louisiana 28 128,667 21.8
Maine 9 13,325 67.5
Maryland 30 154,341 19.4
Massachusetts 26 79,177 32.8
Michigan 43 258,742 16.6
Minnesota 27 30,584 88.3
Mississippi 17 70,443 24.1
Missouri 25 129,297 19.3
Montana 10 12,076 82.8
Nebraska 10 22,024 45.4
Nevada 21 49,989 42.0
New Hampshire 3 11,612 25.8
New Jersey 26 150,391 17.3
New Mexico 2 28,134 7.1
New York 53 482,915 11.0
North Carolina 25 184,832 13.5
North Dakota 5 4,917 101.7
Ohio 49 286,364 17.1
Oklahoma 32 93,380 34.3
Oregon 13 51,497 25.2
Pennsylvania 49 189,297 25.9
Rhode Island(*) 12 20,410 58.8
South Carolina 21 130,515 16.1
South Dakota 6 12,078 49.7
Tennessee 23 83,624 27.5
Texas 89 451,677 19.7
Utah 13 21,834 59.5
Vermont(*) 2 7,468 40.2
Virginia 28 136,814 20.5
Washington 22 72,394 30.4
West Virginia 3 15,175 19.8
Wisconsin 10 66,509 15.0
Wyoming 6 8,821 68.0
Federal Bureau of Prisons 86 528,541 16.3
Total 1339 6,499,221 20.6


(*)Dual system of both pretrial and sentenced inmates

Table 1 also indicates that 31 jurisdictions had suicide rates above the national rate (including extremely high rates in Alaska, Minnesota, Montana and North Dakota). At first glance it would appear that the seven jurisdictions operating dual systems of confining both pre-trial and sentenced inmates, excluding the Federal Bureau of Prisons, had suicide rates that far exceeded the national average. From a low of 15.6 in the District of Columbia to a high of 87.3 in Alaska, these seven dual-system jurisdictions had a combined suicide rate of 34.4 Given that pre-trial inmates appear more vulnerable to suicide and the suicide rate in local jails is estimated to be more than nine times greater than in the community (Hayes 1989), the rate of suicide within dual-prison systems is not surprising.

However, it would appear that the uniqueness of jurisdictions with dual systems is not die sole cause of high suicide rates in prison systems throughout the United States. The analysis found that the seven smallest prison systems (excluding dual systems) of Maine, Montana, New Hampshire, North Dakota, South Dakota, West Virginia and Wyoming had a combined suicide rate of 53.8 -- more than two and a half times greater than the national average.

Further, although it might be assumed that prison systems with high rates of suicide would mirror the suicide rate in their respective communities, the data do not support this proposition. According to National Center for Health Statistics (1993) data, with. the exceptions of Montana and Wyoming, all of the seven smallest and dual-system jurisdictions with high prison suicide rates had general population suicide rates comparable to the national average of 12.2. Perhaps a better explanation for the high prison suicide rates in these states is that, even though all prison systems are plagued by limited resources, the strain may be more acute within smaller jurisdictions.

The most encouraging finding from NCIA's survey is the gradual decrease in the rate of prison suicide throughout the country during the past 10 years. As shown in Table 2, following a high of 27.2 in 1985, the prison suicide rate in subsequent years declined steadily, settling to a low of 16.1 in 1992.

Although the rate of prison suicide rose nationally to 17.8 in 1993, the increase could be indicative of either an upward trend or merely an aberration. In addition, the declining prison suicide rate nationwide during the past 10 years is punctuated by a dramatic drop from 21.7 in 1989 to 16.2 in 1990. In fact, from 1984 through 1989, the rate of prison suicide throughout the United States was 24.5. From 1990 through 1993, however, the rate dropped to 16.6. Although the reason behind this noticeable reduction is unknown, there were several jurisdictions that were primarily responsible for this national decline -- 14 state prison systems experienced suicide rate reductions of 50 percent or more from the period of 1984-1989 to 1990-1993. During 1990-1993, these 14 states had a combined suicide rate of 13.5 -- a decline of more than 60 percent from the 1984-1989 rate of 34.6.

Table 2. Total Prison Suicides and Rates -- 1984-1993

Year Suicides Total Inmate Rate
 Population

1984 121 446,212 27.1
1985 132 485,301 27.2
1986 126 522,780 24.1
1987 139 554,654 25.1
1988 139 598,239 23.2
1989 146 672,193 21.7
1990 118 730,486 16.2
1991 127 774,198 16.4
1992 133 825,322 16.1
1993 158 889,836 17.8
Total 1,339 6,499,221 20.6




What significance can be derived from these findings? While the current data do not allow for a comparative analysis of prison suicide rates and prevention programs, they do provide several interesting findings. First, the rate of suicide in prisons throughout the United States during the past 10 years was calculated to be 20.6 deaths per 100,000 inmates -- a rate more than one and a half times greater than that of the general population, yet far below the rate of jail suicides. Second, states with small prison populations appear to have exceedingly high rates of suicide -- often more than two and a half times greater than the national average. Third, apart from 1993, there has been a gradual yet steady decline in the rate of prison suicides throughout the country since 1984, punctuated by a dramatic decline after 1989. In fact, more than 14 state prison systems have experienced rate reductions of 50 percent or more since 1989.

Fifteen states experienced higher rates of prison suicide during 1993 as compared to their nine-year (1984-1992) averages. Haycock (1991) has written that several recent developing characteristics of prisons are suggestive of higher suicide rates in the future, resulting in a significant public health problem. Recent mandatory sentencing laws and dramatic increases in life sentences have not only put a strain on crowded prison systems, but coupled with increased cases of AIDS and "graying" of inmate populations (in which inmates 55 years and older represent the fastest growing age group), they have instilled despair and hopelessness in inmates. Observers also argue that prison crowding has paralyzed correctional budgets, straining both medical and mental health services.

Standards for Prison

Suicide Prevention

Historically, national correctional standards have been viewed with some skepticism. They have been referred to as too general or vague, lacking in enforcement power and often politically influenced. As one observer noted in reviewing the historical record of national standards for correctional health care, "Courts and correctional administrators seeking specific guidelines as to what constituted `adequate' provisions for health care were not likely to derive much satisfaction from the early standards" (Anno 1991). Further, with regard to current standards, formal adoption of correctional standards by a prison system does not necessarily ensure that individual facilities have put these procedures into operation. Unfortunately, there are numerous examples of "accredited" prison facilities that are under court order for inadequate conditions of confinement.

Most of the national standards were developed as recommended procedures rather than regulations that measure outcome. For example, ACA standard 3-4364 requires a "written suicide prevention and intervention program" in all prison facilities, but offers no guidance as to which components should be included in such a program. The potential result, of course, is that two prison systems could be in compliance with this standard yet have dramatically different procedures. However, despite this problem, the relationship between suicide prevention and national correctional standards has progressed significantly in recent years. Several national organizations, including the ACA, the National Commission on Correctional Health Care (NCCHC) and other influential bodies have recognized that, because suicide remains a leading cause of death in prisons, standards need to be promulgated and revised to address the specific area of suicide prevention. Once a footnote in medical care standards, suicide prevention is now addressed separately and distinctly in most national standards. These standards now provide the opportunity and framework for departments of correction to create and build upon their policies and procedures for the prevention of suicides.

The question remains: Have departments of correction taken advantage of the opportunity to develop suicide prevention policies based on national standards? If so, how comprehensive are these policies? NCIA surveyed all 50 state departments of correction, plus the District of Columbia and the Federal Bureau of Prisons, in an effort to determine the degree to which state prison standards address the issue of suicide prevention. Each DOC was asked the following question: "Has your agency and/or individual facilities developed any policies and procedures relevant to the issue of prison suicide? If yes, please forward a copy of the procedures."

In reviewing the response from each DOC, die determination of what constituted a suicide prevention policy was predicated on two conditions: (1) The spirit of standard 3-4364 of ACA's Standards for Adult Correctional Institutions (1990) which states, in part, that, "There is a written suicide prevention and intervention program that is reviewed and approved by a qualified medical or mental health professional," and (2) the policy was a separate directive within a DOC's operational procedures, or the policy was contained in a separate section of another DOC administrative directive (e.g., medical or mental health).

As shown in Table 3, NCIA's survey findings revealed that 41 departments of correction (79 percent) had a suicide prevention policy; eight departments of correction (15 percent) did not have a suicide prevention policy but had varying numbers of protocols contained in other DOC directives; and three departments of correction (6 percent) did not address the issue of suicide prevention in any written policy or directive.

[TABULAR DATA NOT REPRODUCIBLE IN ASCII]

In order to measure the comprehensiveness of a DOC's suicide prevention policy, both ACA standard 3-4364 and standard P-58 of NCCHC's Standards for Health Services in Prisons (1992) were used. ACA standard 3-4364 states, in part, that, "The program should include specific procedures for intake screening, identification, and supervision of suicide prone inmates." NCCHC standard P-58 states, in part, that, "the facility's plan for suicide prevention should include the following components. identification, training, assessment, monitoring, housing, referral, communication, intervention, notification, reporting and review." For purposes of this analysis, NCIA combined the requirements of both standards and identified die six most critical components in a suicide prevention plan: staff training, intake screening/ assessment, housing, levels of supervision, intervention and administrative review (Hayes 1994).

The NCIA analysis found that only three departments of correction (California, Delaware and Louisiana) had suicide prevention policies that addressed all six critical components, and an additional five departments of correction (Connecticut, Hawaii, Nevada, Ohio and Pennsylvania) had policies that addressed all but one critical component. Thus, only 15 percent of all departments of correction had policies that contained either all or all but one critical suicide prevention component. In contrast, three departments of correction (Arkansas, Indiana and Kentucky) had no suicide prevention policy whatsoever, and 11 departments of correction had policies that addressed only one or two critical components. Thus, more than a quarter (27 percent) of all DOCs had either no policy or a policy that contained only two or less critical suicide prevention components. Finally, the majority (58 percent) of DOCS had policies that contained either three or four of the critical components.

Conclusion

The high rate of prison suicides experienced in 1993 could indicate an upward trend or it could merely be an aberration. Recently, observers have noted that several developing trends suggest higher suicide rates in die future. Efforts to prevent future prison suicides will be predicated on several factors. further research, resources and progressive prison management.

Large-scale, prospective studies of prison suicide and empirical studies on the process of custodial suicide are needed. As the awareness of inmate suicide as a serious health problem within prisons continues to grow, resources must follow. Some encouraging signs are apparent. For example, the National Institute of Corrections currently provides technical assistance to departments of correction in various specialized areas of correctional health care, including the development of comprehensive plans for suicide prevention.

Finally, future success in reducing prison suicides throughout the country will rely not only on developing comprehensive and operational policies, but also on the attitude displayed by prison administrators toward whether to treat the recent increase in prison suicides as an aberration or as a signal of an upward trend.

REFERENCES

American Correctional Association. 1990. Standards For Adult Correctional Institutions (3rd ed.). Laurel, Md.

Anno, B. Jaye. 1991. Prison health care: Guidelines for the management of an adequate delivery system. Washington, D.C.: National Institute of Corrections.

Anno, B. Jaye. 1985. Patterns of suicide in the Texas department of corrections, 1980-1985. Journal of Prisons and Jail Health 5 (2).

Austin, W. T. and C. M. Unkovic. 1977. Prison Suicide. Criminal Justice Review 2 (1).

Batten, Peter J. 1992. The descriptive epidemiology of unnatural deaths in Oregon's state institutions: A 25-year (1963-1987) study. The American Journal of Forensic Medicine and Pathology, 13 (2).

Bureau of Justice Statistics. 1993. Correctional populations in the United States, 1991. Washington, D.C.: U.S. Department of Justice.

California Department of Corrections. 1994. Suicide prevention in the California Department of Corrections: Annual report -- 1993. Sacramento, Calif.

Corrections Compendium. 1992. Survey, inmate escapes, violence and riots (November).

Criminal Justice Institute. 1992. Corrections yearbook -- 1991. South Salem, N.Y.

Haycock, Joel. 1991. Crimes and misdemeanors: A review of recent research on suicides in prison. Omega 23 (2).

Hayes, Lindsay M. 1995. Prison suicide: An overview and guide to prevention. Washington, D.C.: National Institute of Corrections.

Hayes, Lindsay M. 1994. Developing a written program for jail suicide prevention. Corrections Today 56 (2).

Hayes, Lindsay M. 1989. National study of jail suicides: Seven years later. Psychiatric Quarterly 60 (1).

Lester, David. 1987. Suicide and homicide in USA prisons. Psychological Reports 61.

Lester, David. 1982. Suicide and homicide in U.S. prisons. American Journal of Psychiatry 139 (11).

National Center for Health Statistics. 1993. Advance report of final morality statistics, 1991. NCHS Monthly Vital Statistics Report 42 (2, Supp).

National Commission on Correctional Health Care. 1992. Standards for health services in prisons (2nd ed.). Chicago, III.

Salive, Marcel E., Gordon S. Smith, and T. Fordham Brewer. 1989. Suicide mortality in the Maryland state prison system, 1979 through 1987. The Journal of the American Medical Association 262 (3).

Lindsay M. Hayes is the assistant director of the National Center on Institutions and Alternatives. This article is a synopsis of a monograph prepared by the author under a grant from the National Institute of Corrections. Points of view of opinions stated in this article are those of the author and do not necessarily represent the official position or policies of the U.S. Department of Justice. For a copy of Prison Suicide: An Overview and Guide to Prevention, contact the author at 40 Lanter Lane, Mansfield, MA 02048; (508) 337-8806; or the National Institute of Corrections' Information Center, 1860 Industrial Circle, Suite A, Longmont, CO 80501; 1-800-877-1461.
COPYRIGHT 1996 American Correctional Association, Inc.
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1996 Gale, Cengage Learning. All rights reserved.

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Author:Hayes, Lindsay M.
Publication:Corrections Today
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Date:Feb 1, 1996
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